Chemotherapy in metastatic and locally advanced non-small cell lung cancer

The majority of patients with non-small cell lung cancer have locally advanced and metastatic disease at diagnosis. Combination platinum-based chemotherapy is the standard treatment for patients with advanced disease who have a performance status of 0-1. Chemotherapy is superior to supportive care alone in terms of survival, palliation of symptoms, and in many studies, improving quality of life. Newer third generation therapies such as paclitaxel, docetaxel, vinorelbine, and gemcitabine have been proven effective as single agents with minimal toxicity, compared with supportive care alone. In combination with platinum, these agents produce higher response rates than older platinum-based regimens, are associated with additional survival benefits, and are generally more convenient and less toxic for patients. Newer nonplatinum doublets appear equivalent to newer platinum-regimens and have expanded the options available for patients. Targeted agents are promising and may soon offer patients more effective and less toxic therapies. Progress in treatment in the advanced setting has led to advances in the care of locally advanced disease. Combination chemoradiotherapy is a standard treatment for locally advanced disease, and studies with newer agents are in progress.